Evaluation of experimental blunt and penetrating hepatobiliary trauma by sequential peritoneal lavage

Peritoneal lavage, when used in the standard way to detect hemoperitoneum, gives no information regarding site or nature of injury. We think that it would be useful for the surgeon to be more able to characterize intraabdominal injuries preoperatively, and that this may be possible by extending the scope and duration of the technique of peritoneal lavage. To test this hypothesis, we investigated the use of sequential peritoneal lavage with extended chemical analysis to precisely define the nature and extent of hepatobiliary trauma in an animal model. Thirty-six dogs were divided randomly among one control and four experimental groups in which sham laparotomy, blunt thoracoabdominal trauma, direct laceration of the liver, liver laceration plus bowel perforation, and gallbladder perforation were carried out. Sequential peritoneal lavage was performed over a six-hour experimental period with simultaneous serum and lavage samples analyzed for red and white blood cells, bile, and enzyme activity (GOT, GPT, and alkaline phosphatase) at four test intervals up to six hours post injury. Our results demonstrate that enzyme activity is easily detectable in lavage effluent after blunt hepatic injury but not after penetrating trauma, and seems to correlate with the extent of hepatocellular disruption. Lavage white cell counts in excess of those anticipated for hemorrhage alone are present only in association with an inflammatory stimulus other than blood or bile. A lavage-to-serum-bilirubin ratio of one or more can be expected after gallbladder or extrahepatic biliary perforation. This information may be valuable in the emergency assessment of the trauma patient.